Lipid-Lowering Drug Guidelines-MCQs

Lipid-Lowering Drug Guidelines — 60 MCQs with Answers

1. According to ESC/EAS 2023, what is the LDL-C target for ‘very high risk’ patients?
A. <55 mg/dL and ≥50% reduction ✔
B. <70 mg/dL
C. <100 mg/dL
D. <116 mg/dL
Explanation: ESC/EAS define ‘very high risk’ LDL-C target as <55 mg/dL with ≥50% reduction from baseline.

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2. First-line drug class for most patients requiring LDL lowering is:
A. Ezetimibe
B. Bempedoic acid
C. Statin ✔
D. PCSK9 inhibitor
Explanation: Statins are first-line due to consistent ASCVD risk reduction and established safety profile.

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3. High-intensity statin examples include:
A. Atorvastatin 10 mg, Rosuvastatin 5 mg
B. Atorvastatin 40–80 mg, Rosuvastatin 20–40 mg ✔
C. Simvastatin 10 mg, Pravastatin 10 mg
D. Ezetimibe 10 mg
Explanation: High-intensity statins: atorvastatin 40–80 mg or rosuvastatin 20–40 mg (≥50% LDL reduction).

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4. For LDL ≥190 mg/dL (likely familial hypercholesterolemia), recommended initial step:
A. Lifestyle only
B. High-intensity statin ✔
C. PCSK9 inhibitor first-line
D. Fibrate therapy
Explanation: Begin high-intensity statin; add ezetimibe and consider PCSK9 inhibitor if goals unmet.

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5. Ezetimibe provides approximately what incremental LDL reduction when added to a statin?
A. 5–8%
B. 18–25% ✔
C. 40–50%
D. 60–65%
Explanation: Ezetimibe adds ~18–25% LDL reduction when combined with statin therapy.

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6. PCSK9 monoclonal antibodies reduce LDL by roughly:
A. 10%
B. 25%
C. ~60% ✔
D. ~80%
Explanation: PCSK9 mAbs (evolocumab, alirocumab) reduce LDL by ~50–60% on top of background therapy.

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7. Inclisiran is best described as:
A. A monoclonal antibody against PCSK9
B. An siRNA agent reducing PCSK9 synthesis, dosed Day 0, Day 90, then q6m ✔
C. An oral cholesterol absorption inhibitor
D. A fibrate-class drug
Explanation: Inclisiran is an siRNA targeting PCSK9 mRNA given at Day 0, Day 90, then every 6 months.

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8. Which agent showed outcome benefit in statin-intolerant patients (CLEAR Outcomes)?
A. Ezetimibe
B. Bempedoic acid ✔
C. Niacin
D. Fenofibrate
Explanation: Bempedoic acid demonstrated CV outcome benefit in the CLEAR Outcomes trial among statin-intolerant patients.

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9. REDUCE-IT demonstrated benefit in patients with:
A. Very high LDL despite statin
B. Elevated TGs (135–499 mg/dL) on statin therapy ✔
C. Isolated low HDL
D. Severe hypertriglyceridemia >1000 mg/dL
Explanation: REDUCE-IT enrolled patients with TG 135–499 mg/dL on statins and found reduced major CV events with icosapent ethyl.

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10. ACC/AHA recommends adding ezetimibe in ASCVD patients when LDL remains ≥:
A. ≥55 mg/dL
B. ≥70 mg/dL ✔
C. ≥100 mg/dL
D. ≥116 mg/dL
Explanation: ACC/AHA suggests ezetimibe for ASCVD patients with LDL ≥70 mg/dL despite maximally tolerated statin.